What Happens on my First Visit to a Psychologist?
Once you have the name of a practitioner and make a first appointment, it is usual for him or her to ask you to describe your problem and to ask for details about your personal history. These questions will include such things as when did your problem start, what makes it better or worse, how does the problem affect your work or social life. Questions about your personal history can include details about your experiences growing up, your education and work history, your marital status and interpersonal relationships, and whether you use medication, alcohol or drugs. This information-gathering phase can take one or more sessions and may be supplemented by the use of psychological tests.
Psychological tests are used to gain a better understanding of the kind of problem in thinking, feeling or behaviour a person presents. If a psychologist plans to use a test, he or she should explain why it is being used and what kind of function it is used to assess. For example, some tests are used to assess and help diagnose mood, some are used to assess problems in memory or concentration, and some might be used to better understand personality characteristics. For example, some are pencil and paper tests that pose questions to which you must answer true or false and others might require you to manipulate objects or remember numbers or phrases. Testing is used to help the psychologist arrive at an impression or diagnosis of your particular problem.
Following the information-gathering phase which may or may not include psychological testing, it is important that the psychologist discuss with the client (and/or his or her parent or guardian if a child) what he or she thinks is wrong and what he can offer in the way of help. Reasonable questions to ask a psychologist are:
- Have you treated many people with this kind of problem?
- What kind of psychotherapeutic approach do you use and how does it work?
- What kind of success can I expect?
Treatments or psychotherapeutic approaches used by psychologists should be empirically-supported treatments – in other words treatments which research has proven to be effective. Common types of treatments include cognitive-behavioural therapy, interpersonal therapy, and systems therapy among others. Treatment might be offered in an individual, group, couple or family format depending on the problem and whom it affects.
What Happens During Psychological Treatment?
Early on in the treatment, the psychologist will help you make goals to work towards and identify the ways therapy will help you achieve them. Goals can include feeling less depressed, feeling more comfortable in social situations, improving pain management, changing your behaviour, or increasing self-esteem. In addition, the psychologist will review your progress in meeting these goals at certain intervals and may have you fill out questionnaires designed to help monitor progress.
Important things to remember about psychological treatments are that it can be hard work to change feelings, thoughts and behaviour – you have to be ready to commit yourself to attend sessions regularly and follow through on recommendations. One thing that can not be changed is the past but you can change how it affects you. It is also difficult to change the behaviour of other people. Psychological treatment is primarily focused on helping you make personal changes to improve your life.
There is often more than one way to solve or manage a psychological problem – which one to choose can depend on the training of the practitioner and the characteristics of the client. Finally, you are entitled to be an informed consumer and active participant in the psychological treatment process – if you have questions or concerns, let the psychologist know!
Do Medications Work?
It is important to recognize that medications most often manage, but do not cure psychological problems or mental disorders, as is the case for other types of physical problems. For example, if you have an infection and take antibiotics, the infection typically goes away. However, if you have diabetes, you may need to take insulin for the rest of your life.
Most medications for psychological problems or mental disorders do not cure the disorder but relieve it and make it easier for the person to manage, often with the help of psychotherapy. As mentioned, there are some mental disorders for which medications are very necessary (schizophrenia and some depressions for examples). Research tells us that medication and psychotherapy work better than either medication or psychotherapy alone in managing some types of psychological problems. Some types of problems might even be better managed with psychotherapy alone.
How are Psychological Services Paid?
In Canada, the services provided by a psychologist are covered by provincial health insurance only if the psychologist is employed by, for examples, a hospital, correctional facility, community clinic, social agency or school.
The services provided by a psychologist in private practice are not covered by provincial health insurance plans and the psychologist bills the patient directly. Many people have extended health benefits through their employers that cover some amount of psychological service annually. The services of a psychiatrist, whether they work in a hospital, clinic or in a private office, are covered by provincial health insurance plans. As is the case for psychologists employed in hospitals or schools, wait lists to see a psychiatrist can be long.
What Happens to the Personal Information I Discuss with my Psychologist?
In consulting a practitioner about personal psychological problems, people are often concerned about confidentiality. Early on when seeing a client, the psychologist should review the limits of confidentiality. Information disclosed to a psychologist is confidential and cannot be disclosed without the client’s consent except under certain specific conditions. These conditions are referred to as the “limits of confidentiality”. These limits typically involve situations where the client gives the psychologist information that leads him or her to suspect that harm might come to someone. If a psychologist suspects that a client is going to harm himself or someone else, that a child is being abused or neglected, or that another health care practitioner has sexually abused a patient in some way, then he or she has an obligation to report this information to the appropriate authority (the police or children’s aid society for examples). The courts also have the power to subpoena a psychologist’s files.
Psychologists must retain records of their contacts with clients and these records typically include details about the clients presenting problem and history, psychological test data and any diagnoses made, as well as details about sessions attended. These records must be kept and stored securely for periods of time defined by provincial regulation. Typically, records are kept for 10 years after the last client contact and for at least 10 years after a minor client reaches the age of majority. After the 10 years are up, files are securely discarded by being shredded.